Knee Prosthesis in the Computer Era

Sezer, Hasan Basri; Bohu, Yoann; Hardy, Alexandre; Lefèvre, Nicolas

doi:10.1111/os.12762

Cited by 5 publications

(5 citation statements)

References 67 publications

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“…T otal knee arthroplasty (TKA) is the only effective treatment for end-stage knee osteoarthritis. While many surgeons follow Install and Ranawat's mechanical alignment principle (IRMP) 1 to achieve a durable and successful TKA 2,3 , 20% of patients are not satisfied with their results. 4,5 The IRMP refers to two lines on the coronal plane of the lower limb: the vertical force line (referring to making osteotomies of the distal femur and proximal tibia) and the joint line (a line at the keen joint level perpendicular to the vertical force line obtained after the prosthesis has been implanted).…”

Section: Introductionmentioning

confidence: 99%

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Implication of Changes in the Imaging Measurements after Mechanically Aligned Total Knee Arthroplasty

Cheng

Ren

Zheng

et al. 2022

Orthopaedic Surgery

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Objective Imaging measurements allow assessment of the mechanical alignment before and after total knee arthroplasty (TKA). The changes in radiographic parameters in each period of time within 1 year after TKA has been poorly understood. The purpose of this study was to examine the timing and causes of imaging changes in lower extremity force lines after total knee arthroplasty with mechanical alignment. Methods A total of 93 mechanically‐aligned TKA were radiographically examined before, 3 days, 3 months, and 1 year after surgery. Radiographic parameters included hip‐knee angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), knee joint line orientation (KJLO), ankle joint line orientation (AJLO), the knee joint line relative to ankle joint line angle (KJLTA) and midpoints of the ankle distance (MAD). Paired t‐test were used to analyze the changes of these imaging parameters, By establishing a simple tibial model, the time points of changes in the imaging parameters after TKA was determined, with an attempt to understand the post‐TKA changes in these imaging parameters. Results Statistically significant differences were found between the preoperative data and the data measured 3 days after surgery in HKA, LDFA, MPTA, MAD, KJLTA, AJLO (P < 0.05) while KJLO exhibited no significant difference (P = 0.089). There existed significant differences between the data measured 3 days and the measurements taken 3 months after operation in HKA, MPTA, KJLTA, KJLO, AJLO (P < 0.05), whereas LDFA and MAD showed no significant difference (P > 0.05). Significant differences were revealed between the data measured 3 months and those collected 1 year after surgery in LDFA, MPTA, AJLO, KJLTA (P < 0.05) but HKA, KJLO, AJLO showed no significant differences (P > 0.05). The tibial model was made to look into the changes in postoperative imaging parameters. ΔMAD and postoperative AJLO were calculated to verify the model and hypothesis. Conclusions Postoperative changes in radiographic parameters and tibial models showed that the lower extremities were in an unnatural state within 1 year after TKA. The changes in the lower extremities force line were the results of the gradual adaptation of the lower extremities to TKA and the lateral swing of the extremities (3°) after surgery. Imaging data 1 year after surgery should be taken into account in the explanation of post‐TKA changes in lower limb force lines.

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Section: Introductionmentioning

confidence: 99%

“…Total knee arthroplasty (TKA) is the only effective treatment for end‐stage knee osteoarthritis. While many surgeons follow Install and Ranawat's mechanical alignment principle (IRMP) 1 to achieve a durable and successful TKA 2 , 3 , 20% of patients are not satisfied with their results. 4 , 5 …”

Section: Introductionmentioning

confidence: 99%

Implication of Changes in the Imaging Measurements after Mechanically Aligned Total Knee Arthroplasty

Cheng

Ren

Zheng

et al. 2022

Orthopaedic Surgery

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“…TKA is a widely performed, mature, and effective orthopaedic surgery, which is often used to correct knee joint deformity, remove knee joint pain, and restore knee joint function 12 , 13 , 14 . The standard approach for TKA is the MPA.…”

Section: Discussionmentioning

confidence: 99%

The Comparison between Mini‐Subvastus Approach and Medial Parapatellar Approach in TKA: A Prospective Double‐Blinded Randomized Controlled Trial

Geng

et al. 2022

Orthopaedic Surgery

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Objective Minimal invasive approach has been increasingly used in total knee arthroplasty (TKA) and more is expected of early rehabilitation in terms of pain release and recovery of knee function. The approach type is one of the major factors that determines the early rehabilitation after TKA. The purpose of this study is to determine whether mini‐subvastus approach (MSVA) is superior to the traditional medial parapatellar approach (MPA) in TKA. Methods From 2018 to 2019, a randomized double‐blinded prospective study was conducted on 58 patients who underwent simultaneous bilateral TKA. The subjects included eight men and 50 women, with an average age of 65 years. One side was randomized using MSVA and the other side using MPA. Visual analog scale (VAS), operative duration, recovery time to straight leg raising (SLR), range of motion (ROM), HSS score, release rate of lateral retinaculum, satisfaction rate were recorded and compared. Paired‐samples T test were used for quantitative data and chi‐square test for qualitative data. Results There was no statistical difference in the ratio of left and right sides, preoperative ROM, VAS, HSS score, muscular strength of lower limbs, KL grade, operative order, and operative duration between the two groups. The average ROM (118.91 ± 8.21 vs. 107.60 ± 7.99, t = 14.320, p = 0.0000) and HSS score (72.03 ± 4.55 vs. 61.22 ± 4.36, t = 13.095, p = 0.0000) on POD 3, VAS in rest and motion on POD 1 and 3, the recovery time to SLR (1.17 ± 0.38 vs. 3.09 ± 0.76, t = 19.902, p = 0.0000), and the satisfaction rate on POD 1 (96.55% vs. 74.14%, χ2 = 9.9251, p = 0.0016) were superior in the MSVA group over MPA group. ROM in rest and motion and HSS score on POD 30 had no difference. The release rate of lateral retinaculum was less in the MSVA group than in the MPA group. The mean value of HKA, FFC, and FTC and the proportion of outliers did not differ significantly between the two groups. Conclusions Compared with MPA, MSVA can make ROM of knee and SLR recover earlier, reduce postoperative pain after TKA, improve the early postoperative satisfaction and reduce the lateral release rate. MSVA can be used as a favorable measure in the concept of enhanced recovery after surgery (ERAS).

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“…There is an abundance of evidence that computer navigation produces better precision than conventional instrumentation, but only limited evidence that this translates into better clinical outcomes ( 36 ). Although recent reviews revealed the superiority of the navigation-TKA technique over the conventional technique remains uncertain in the short and long term, the use of computer navigation TKA is an example of an initiative to augment human decision-making and surgical handicraft with artificial intelligence ( 37 ).…”

Section: Discussmentioning

confidence: 99%

Alignment analysis of Brainlab knee 3 navigation-guided total knee arthroplasty using the adjusted mechanical method

Pan

Jiang

et al. 2022

Front. Surg.

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PurposeWith the application of navigation technology in Total Knee Arthroplasty (TKA), TKA procedures have become various. Studies have shown that navigation can improve the alignment of patients' lower limbs. To verify this conclusion, we collected the clinical data from patients who underwent Brainlab knee 3 navigation-guided TKA. Brainlab knee 3 is a completely new software that takes a different approach to address the current challenges of navigated TKA. During the procedure, we applied the Adjusted Mechanical Alignment (AMA) principle and took soft tissue balance as a priority. We aim to explore the patients’ lower limb alignment changes who underwent the Brainlab knee 3 navigation-guided TKA using the AMA method.MethodsFifty consecutive patients who underwent total knee arthroplasty using the Brainlab knee3 knee navigation system (Smith&Nephew) from January to August 2021 by the same doctor (Yunsu Chen) in the Department of Joint Surgery of the Shanghai Sixth People's Hospital were included. Hip-Knee-Ankle Angle (HKAA), anatomic Femur Tibia Angle (FTA), Lateral Distal Femoral Angle (LDFA), and medial proximal tibia angle (MPTA) were measured on preoperative and postoperative full-length lower-limbs x-ray films or weight-bearing anterior and lateral knee radiographs for observational and descriptive study. The preoperative and postoperative knee alignment changes were analyzed through paired t-test or nonparametric Wilcoxon test using SPSS 25.0 softwareResultsPre-operative and post-operative HKAA both obeyed normal distribution. The mean preoperative HKAA was 169.8° (154.9–178.7°) with a standard deviation of 5.41; the postoperative HKAA was 175.7° (168.4–180.0°) with a standard deviation of 2.81. Using the two-sample paired t-test to analyze, the result showed P = 0.000 < 0.05; a statistically significant difference exists. The preoperative and postoperative FTA obeyed normal distribution as well. The mean preoperative FTA was 174.7° (163.4–179.9°) with a standard deviation of 3.90; postoperative 175.6° (167.0–179.9°) with a standard deviation of 2.77. Using the two-sample paired t-test to analyze, the result showed P = 0.140 > 0.05, the difference was not statistically significant. The preoperative LDFA was normally distributed, while postoperative LDFA was not. The mean preoperative LDFA was 90.7° (83.5–99.6°) with a standard deviation of 3.83; the median of postoperative LDFA was 91.6° (86.0–103.2°) with an interquartile range of 2.93. Using the two-sample paired Wilcoxon test, the result showed P = 0.052 > 0.05; the difference was not statistically significant. Preoperative MPTA obeyed normal distribution, while postoperative MPTA did not. The mean preoperative MPTA was 83.5° (72.7–92.9°), with a standard deviation of 3.66; the median of postoperative MPTA was 89.3° (84.6–95.6°), with an interquartile range of 1.45. Using the two-sample paired Wilcoxon test, the result shows P = 0.000 < 0.05; a statistically significant difference exists.ConclusionIn our study, AMA alignment was applied in Brainlab Knee3 computer navigation-assisted total knee arthroplasty. The femoral and tibial osteotomy angles were minimally adjusted according to soft tissue situations to reduce soft tissue release. We found AMA alignment provides good control of knee alignment in the coronal plane of the lower limbs, which is a reliable technique.

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Knee Prosthesis in the Computer Era

Cited by 5 publications

References 67 publications

Implication of Changes in the Imaging Measurements after Mechanically Aligned Total Knee Arthroplasty

Implication of Changes in the Imaging Measurements after Mechanically Aligned Total Knee Arthroplasty

The Comparison between Mini‐Subvastus Approach and Medial Parapatellar Approach in TKA: A Prospective Double‐Blinded Randomized Controlled Trial

Alignment analysis of Brainlab knee 3 navigation-guided total knee arthroplasty using the adjusted mechanical method

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